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Home My WebLink AboutBUSINESS PLAN 7/13/2001Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE PERMIT ID # 015-021-002212 WESTERN DENTAL LOCATION 4401 c~ This rmrmit is issued for the followin_n. [] Hazardous Materials Plan [] Underground Storage of Hazardous Materials [] Risk Management Program [] Hazardous Waste On-Site Treatment Issued by: Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES' 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 Approved by: Expiration Date: Office of Evironm~l~Servic~ June 30:2003 JUL / 7 Z00I Issue Date . LO~ ~-~ ,ill M~r. Lcunge Offk:e Wa, itin6 Office/Reception ! k'~7~OYEES ARE TO MEET AT TH~ k~D OF %/{E PARKING LOT, AT THE LIGHT -Western Dental Services - Bakersfield ~', You a~e here Emer§ency Exit Route ~ Fire Ex~nguisher i SITE DIAGRAM Business Name: Business Address: FACILITY DIAGRAM SITE DIAGRAM Business Name: L~ ~'~..~" r~ ~usln~ Address: ~ ~ .+_ ~'ACILFFY DIAGRAM ~~o.~ . , , / --l Fire' ~ FiFICE OF ENVIRONMENTAL SERVICES ~nnrm~r 1715 Chester Ave., Bakersfield, CA (660 S26-397b HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 2. 3. 4. 5. To avoid further action, return this form within 30 days of receipt. TYPE/PRINT ANSWERS IN ENGLISH. Answer the questions below for the business as a whole. Be as brief and concise as possible. You may also attach Business Owner / Operator Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUS.ESS IDENTIFICATION DATA PRIMARY ACTIVITY: oW R: e_3+,r MAILING ADDRESS: .._~Q,. PHONE:7 IL/~L/ EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR. PHONE (.&,\ l kS-qq 3o SECT[ON II. l. DISCOVERY AND, NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: B. EMPLOYEE AND AGENCY NOTIFICATION: C. E~O~~ ~SPONSE ~AGE~: . ... Do EMERGENCY MEDICAL PLAN: 2 HAZ~DOUS MATERIALS MANAGE~T PLAN SECTION II.2: RELEASE RESPONSE PLAN Ao Bo RELEASE CONTAINMENT AND/OR MITIGATION: C. CLEAN-UP AND RECOVERY PROCEDURES: b' ~Y ~. Pt~t~ S:ff- z~B)~ V'~ ~~ ~ .... ~ UTILITY SHUT-OFFS (LOCATION 'OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: ELECTRICAL: WATER:' sPic. L: oc uox: PRIVATE FIRE PROTECTION/WATER AVAILABILITY Ao WATER A ~AILABILITY (FI,RE HYDRANT): 3 SECTION III: TRAINING NUMBER OF EMPLOYEES: MATERi~L SAFETY .DATA SHE. ETS ON FILE: W~r:-- ~T~- _ __~ ,. ~ ~. <h,,& ~s~3. CERTIFICATION CERTIFY THAT THE ABOVE INFORMATION THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE ~INFORMATIQN CONST1TUTtES P~ERJURY. II^Z MAT MNOIvflqT PLAN & INSTRUC~ 4 EMERGENCY ACTION RESPONSE In case of a FIRE 1. Remain calm. 2. Call 911 and report the fire. 3. If you can safely get to the gas lines located in the lab, turn them off. 4. Evacuate all patients and employees from the building. 5. Meet at the assigned area according to the office Evacuation Plan. 6. When you are safe, call the Corporate Office to report the fire at (800) 992-3366. In case of a devastating (major) EARTHQUAKE 1. Remain calm. 2. Get into a doorway (not a glass one) and stay there until the shaking stops. 3. When the shaking stops, if you can safely get to the gas lines located in the lab turn them off. 4. Check for damaged. 5. Evacuate all patients and employees from the building. 6. Meet at the assigned area according to the office Evacuation Plan. 7. When you are safe, call the Corporate Office to report the earthquake at (800) 992-3366. In case of an ARMED ROBERY 1. Cooperate and try to remain calm. 2. Do not endanger yourself or the other staff members. 3. When safe, call 911 and report the robbery. 4. Call the Corporate Office to report the incident at (800) 992-3366. In case of Minor a HAZARDOUS CHEMICAL Emergency FIRE 1. Evacuate all patients and employees from the building. 2. CALL 911 and report the fire. 3. Call the Corporate Office to report the incident at (800) 992-3366. Spills 1. Evacuate the immediate area. 2. Follow the instructions that are in your "Spill Kit." 3. Call the Corporate Office to report the incident at (800) 992-3366. Facility Emergency Coordinators Managing Doctor (name) Emergency Agencies Fire Dept., Ambulance, POLICE {~{:> I' ~2c] /4' ~-~] '2_ Office of Emergency Service County's Hazardous Materials Compliance Division Office Manager ,~(nha~fi~. e) ~0' f + ~ I~' Floor Supervisor (name) Telephone Number 911 1 (800) 825-7550 LMHentosz 12/92 Revised 9/98 DLW W:\Quality\OSHA\Master Gray Originals\149 Emergency Action Response.doc Page 1 of 1 Medical Emergency / Code Blue All staff members must be trained and understand how to respond to a Medical Emergency / Code Blue. 1. Call out to other staff members using the term "CODE BLUE" in room (location where emergency is at). 2. Remain calm; never leave the patient unattended. 3. The first person responding to the Medical Emergency/Code Blue must get the Medical Emergency Kit and Oxygen tank. ALL staff members must know the location of the Medical Emergency Kit and Oxygen Tank. o Staff members not involved in assisting the Medical Emergency/Code Blue should monitor other patients, keep hallways clear, and carry on with normal duties if possible. Doctor is to assess the Emergency and inform staff if they need to call 911, give a brief description of emergency. Assessment should include but not limited to the following: a. Assist patient/staff as needed (CPR) etc. b. Evaluate Medical History. Co Prepare emergency medical information for transport of patient. Information must include name, date of birth, past medical history, current medications and allergies. d. After patient is stabilized and transported to hospital, notify patient's family of medical emergency and location of hospital. DLW 9/99 Adapted from American Heart Association W:\Quality\OSHA\Master Gray Originals\150 Medical Emergency Code Blue.doc Page 1 of 1 Emergency Spill Instructions 1. Remove all people from the spill area. 2. Put on the Personal Protective Equipment located in the spill kit. (Gloves, mask, eye protection, etc.) 3. Pour the absorbent (sand) in a circle around the spill. 4. Using the broom in the spill kit sweep the absorbent into the center of the spill. 5. Do not allow any liquid to escape beyond the absorbent circle. 6. Sweep the absorbent into the center of the circle so that the liquid will be absorbed. 7. Remove everything from the spill kit container. 8. Use the scoop (dust pan & broom) to collect the absorbent, and place into the container. 9. Place all other contaminated clothing or other items into the container and close the container. 10. Place a secondary label (MSDS label) on the container that represents the chemical that was spilled. 11. Store the spill in the same area with other "Hazardous Waste" 12. Call Western Dental Corporate (714-571-3623) (Dori Longworth) to inform. 13. Call Stericycle at (800) 777-3363 for additional instructions. The Stericycle driver will pick up the spill when they pick up your other Hazardous Waste. Order another "Spill Kit" for Facilities at Corporate. DLongworth 12-00 105B Emergency Spill kit, Hazardous Waste Management Plan WESTERN DENTAL Manager: City : BAKERSFIELD CommCode: BAKERSFIELD STATION 07 EPA Numb: /~asPhone: j~-~p : 123 Grlid: llA SIC Code: DunnBrad: SiteID: 015-021-002212 (661) 397-7400 CommHaz : Minimal FacUnits: 1 AOV: .~L.z~_._~mergency C~nt~ct / Title, Business Phone: (661) 397-7400x 24-Hour Phone : (~o~)qt~ -~qg~x Pager Phone : (~&l)~5~ -~3~Fx Emergency Contact / ~ .Title Business Phone: (~:~,l)5~ -TqDOx 24-Hour Phone : (~8) ~/q -~x Pa~er Phone : ( ~ - ~{azmat Hazards: Contact : MailAddr: 4401 MING AVE City : BAKERSFIELD Owner WESTERN DENTAL React Phone: (661) 397-7400x State: CA Zip : 93309 Phone: (~$Ox Address : '~~ITIC--~VE%-~O ~. f'tloo...~ City : B~~L~ Period : Preparer: Certif'd: to State: CA Zip : ~ ~2.~& 5 TotalASTs: = Gal TotalUSTs: = Gal RSs: No Emergency Directives: = Hazmat Inventory --Alphabetical Order Hazmat Common Name... WASTE FIXER One Unified List Ail Materials at Site [SpooHaz[EPA HazardsI Frm DailyMax Unit MCP R ~],~)Of' ~'0%qtOOY'~' gO h.r~by c~Ai~ lhal [ have reviewed the a~ached h~ardous materials manage- - (Name o~ 8us~ne~) any c0~e~0ns c0nsfilule a c0mp~e~e and c0~re~ man- agemen~ plan for my facili~. L GAL Min -1- 05/16/2001 WESTERN DENTAL SiteID: 015-021-002212 ---- Inventory Item 0001 Facility Unit: Fixed Containers at Site ~tv~v~ ~vt~ / ~F! ± ~.tJ ~v~ WASTE FIXER ~ Days On Site 365 Location within this Facility Unit Map: Grid: CAS# FSTATE ~ TYPE Liquid I Waste PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container GAL AMOUNTS AT THIS LOCATION Daily Maximum GAL Daily Average GAL %Wt. I Silver HAZARDOUS COMPONENTS S CAS# N 7440224 TSecretNo RN~oRSBi°HazNo HAZARD ASSESSMENTS Radioactive/Amount EPA Hazards No/ Curies R NFPA /// USDOT# MCP Min -2- 05/16/2001 Wes ern 0 Den S E R V I C E S, I N C. July 13,2001 Environmental Services 1715 Chester Ave. Bakersfield, CA 93308 Dear: Esther Duran This is in response to the inspection that was conducting at Western Dental 4401 Ming Ave. Enclosed you will locate the "Hazardous Waste Management Plan" you requested for this office. Thank you for your assistance in this matter. If I may be of any further assistance you may call me at 714-571-3623. ;cerely~, ~ Dori Longworth Infection Control/OSHA Compliance Director WESTERN DENTAL SERVICES, INC. P.O. Box 14227 Orange, CA 92863 Phone (800) 417-4444 [] BAKERSFIELD [] FRESNO *[] SAC NTO 4401 Ming Ave, 4901 E. Kings Canyon Rd. 5247 EIkT~orn Blvd., Ste. C Ortho (916) 344-1600 [] SACRAMENTO 1355 Florin Rd. (916) 424-1400 *r~ SACRAMENTO 4401 Florin Rd. (9t6) 428-4000 (¢61) 397-7400 (559) 456-1600 *Ii BAKERSFIELD [] FRESNO 4409 Ming Ave. 1255 West Shields Ave. Ortho (661) 835-5800 (559) 227,4000 *ri BERKELEY [] HAYWARD 115 Berkeley Square 123 W. Jackson St. (510) 540-8400 (510) 887-5700 Ortho (510) 540-8400 *CI MERCED Ortho (916) 429-4730 *Ii CLOVIS 1124W. O~veAve.,Ste. 101 [] SACRAMENTO 751 W. Shaw Ave. (209) 383-5000 1701 Watt Ave. (559) 323-5500 Ortho (209) 383-7500 (916) 973.1200 - -.Ortho (~9);2~-;01~ - D..UQOESTO,- - - *El S_AUN_AS_ *ri CONCORD 2045 Briggsmore Ave. 1229 N. Main St, 1821 Concord Ave. (209) 527-3000 (831 ) 442.8000 Ortho (a31) 442-8000 (925) 825.8900 [] OAKLAND Ortho (925} 825-4500 1530 Broadway ri SAN FRANCISCO 1282 Market Street *ri FAIRFIELD (510) 251-1000 (415) 552-1200 2440 N. Tex~s St. [] REDWOOD CITY ri SAN FRANCISCO (707) 422,4600 975 Veterans Blvd, 2813 Mission Street Ortho (707) 422-4440 (650) 365-8900 (415) 285.7600 ri FREMONT [] REDDING ri SAN JOSE 3055 Mowry Avenue 1350 Chum Creek Rd,, #Fl 48 Santa Clara Street (510) 494.9000 (530) 224-9700 (408) 293-7000 *r-'l FREMONT [] SACRAMENTO *[] SAN JOSE 38780 Pasco Padre Parkway 5261 Elkhorn Blvd. 1871 Camden Ave. Ortho (510) 494-8400 (916) 344-1500 (408) 377-5700 Pa~ial list. Additional Ioca#ons available Ortho (408) 377-8400 * ORTHO DEFT. IN OFFICE ~' ADDITIONAL OFFICES ON BACK SIDE 9goo-aag (ooe) I. S~flOH 301gdO ~3/dV Sll~O AON3~)H:IlN3 30NV^QV N131~QgHOSgB O/XjIION 35Vggd cont'd.. '0 SANTA MARIA [] STOCKTON 2205 S. Broadway 1407 W, March Lane (805) 347-1000 (209) 473-4000 Ortho (805) 347-0040 *FI TURLOCK *[] SANTA ROSA 703 N. Golden State B~d. 1240 Farmers Lane (209) 634-0500 (707) 542-5200 Ortho (209) 634-0800 *[]~STOCKTON *[~ VISALIA ;678 N. Wilson Way 828 S. Mooney Blvd. (209) 937-9000 (559) 636-6000 Ortho (209) 460-1501 Ortho (559) 636-2121 PaPal I~ - Addi~onal Ioca~ons available * ORTHO DEFT, IN OFFICE YUBA CITY 727 Colusa Avenue (530) 751-0300 Ortho (530) 751-2999 Fon'n 0014:: (Rev. 09/99) CITY OF BAKE~RSFIELD FIRE DEPARTMENT' OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~<~cI'C-~ D~,-rr'~c~ INSPECTIONOATE ! Section 4: tlazardous Waste Generator Program EPA ID # ~4t//k [] Routine ~ Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number (Phone: 916-324-1781 to obtain EPA ID #) Authorized for waste treatment and/or storage Reported release, fire, or explosion within 15 days of occurrence Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kepi closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line Secondary containment provided Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste Proper management of lead acid batteries including labels Proper management of used oil filters Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal Inspector: Office of EnvironmentaiServices (661) 326-3979 ~ ' Business Si~e Responsibl~ Party White - Env. Sves. Pink - Business Copy